Differential Diagnosis for Elderly Person with Chronic Nausea and Vomiting

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This is a common condition in the elderly, often exacerbated by decreased lower esophageal sphincter tone, increased intra-abdominal pressure, and other factors such as diet and medications. Chronic nausea and vomiting can be prominent symptoms.

Other Likely Diagnoses

• Gastroparesis: Delayed gastric emptying can cause chronic nausea and vomiting, especially in diabetic patients or those with a history of gastric surgery.
• Constipation: Although not typically thought of as a cause of nausea and vomiting, severe constipation can lead to these symptoms, especially in the elderly.
• Medication Side Effects: Many medications commonly used in the elderly, such as opioids, anticholinergics, and certain antibiotics, can cause nausea and vomiting.
• Chronic Kidney Disease: Uremia from advanced kidney disease can cause nausea and vomiting.

Do Not Miss Diagnoses

• Mesenteric Ischemia: Although less common, this condition can present with chronic nausea and vomiting, especially if there's a history of vascular disease. It's critical to diagnose early to prevent bowel infarction.
• Small Bowel Obstruction: Partial obstructions can cause chronic symptoms, and early diagnosis is crucial to prevent complications like bowel ischemia.
• Pancreatic Cancer: While not the most common cause, pancreatic cancer can present with chronic nausea and vomiting, especially if there's associated weight loss or jaundice.
• Increased Intracranial Pressure: Rarely, increased intracranial pressure from any cause (e.g., tumor, hemorrhage) can present with chronic vomiting, often worse in the morning.

Rare Diagnoses

• Cyclic Vomiting Syndrome: A rare condition characterized by recurrent episodes of severe vomiting lasting hours to days, with periods of normal health in between.
• Rumination Syndrome: A condition where food is regurgitated and then chewed and swallowed again, which can lead to chronic nausea and vomiting.
• Eosinophilic Gastroenteritis: A rare inflammatory condition of the gastrointestinal tract that can cause chronic nausea, vomiting, and abdominal pain.
• Neurological Disorders (e.g., Parkinson's Disease, Multiple System Atrophy): Certain neurological conditions can affect the gastrointestinal system, leading to chronic nausea and vomiting.